Human Resources

in Long-Term Care Services

- Japan’s Case -

MASAHIRO MORI NY Representative for

MHLW, Japan

Figures estimated in 2012

(Population estimated of Japan) Actual figure

(National Census)

0

20

40

60

80

100

120

140

1950 1960 1970 1980 1990 2000 2010 2015 2025 2035 2045 2055

61.3%

*1

26.0%

*1

1.42

(2014)

127.0mln (*1)

116.6 mln

36.8 mln

67.7 mln

12.0 mln

86.7mln

34.6mln

44.1 mln

7.9 mln

2014

In 2060, the total population will drop below 90 million

while the aging population ratio will exceed 40%.

Population (million)

Productive age (15 – 64 years

old) population ratio

Population of 15 - 64

years

Population of 14 years

old and below

Aging population

(65 years old and above)

ratio

Population of 65 years

old and above

Total fertility rate

Productive age

population ratio

50.9%

Aging

population

ratio

39.9%

Total

fertility

rate

1.35

Sources: Ministry of Internal Affairs and Communications National Census and Population Statistics, National Institute of Population and Social Security Research Future Population Projections for Japan

(January 2012 estimate): Moderate-range Projects for Births and Deaths (Each year’s population is as of October 1)

Ministry of Health, Labour and Welfare Population Survey Report

(*1) Source: Ministry of Internal Affairs and Communications, FY2014 “Population Estimates” (The 2010 Population Census shows Japan has a population of 128,060,000, a productive-age population ratio of

63.8%, and a population aging rate of 23.0%.) 1

(Source) Ministry of Internal Affairs and Communications National Census and Population Statistics, National Institute of Population and Social Security Research Future Population Projections for Japan

(January 2012 estimate): Moderate Projections for Births and Deaths (Each year’s population is as of October 1)

1990 (Actual figure) 2025 2060

People 75 years old and

above: 597 (5%)

People 65-74 years old:

892 (7%)

Total population:

123.61 million

Total population:

120.66 million

People 65-74 years old:

1,128 (13%)

People 20-64 years old:

4,105 (47%)

People 19 years old and

below: 1,104 (13%)

Total population:

86.74 million

75

65

Age

10,000 250

10,000 10,000

50 100 150 200 250 0

People 75 years old and above:

2,336 (27%)

People 20-64 years old:

7,590 (61%)

People 19 years old and

below: 3,249 (26%)

20

50 100 150 200 0 250

People 19 years old and

below: 1,849 (15%)

People 75 years old and above:

2,179 (18%)

People 65-74 years old:

1,479 (12%)

People 20-64 years old:

6,559 (54%)

150 200

In 2025, all baby boomers reach the age of 75.

0 50

2014 (Actual figure)

People 65-74 years old:

1,708 (13%)

People 75 years old and

above: 1,592 (13%)

Total population:

127.08 million

People 19 years old and

below: 2,224 (17%)

People 20-64 years old:

7,184 (56%)

50 100 0

Baby boomers

(born in 1947-49)

Second-generation

baby boomers

(born in 1971-74)

100 150 200 10,000

250

2

10(0.8%) 18 27 32 40 45 50 56(3.2%)

321 339 375 419 492 548 603 640 678 724 753 782 836 869

895 (50.7%)

4.8（8.7%） 59 72

88 104

125 141

155 166 190

210 230

264 286

306 (17.3%)

180 237 277

342

368

413 397

391 371

423 432

458

485 502

507 (28.7%)

2,180

2,580

3,030

3.480

3,870 4,110

4,350 4,410 4,550

4,690 4,870

5,080 5,330

5,640 5,860

0

1.000

2.000

3.000

4.000

5.000

6.000

0

500

1.000

1.500

2.000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

訪問系

通所系

入所系

小規模多機能型居宅介

護など

(32.7%)

(13.0%)

(53.5%)

(32.8%)

(58.5%)

(thousand)

549 635

724

849

964

1,086 1,141

1,196 1,233

1,363 1,427

1,509

1,630

People requiring care (thousand)

Source: MHLW

1,765

The number of employees for long-term care services has tripled

since long term care insurance system was implemented.

1,708

3

employee

Day care service

In- home service

facility service

Multi functional service

*) FY2010: the ratio is calculated without Iwate, Miyagi and Fukushima Prefecture due to Tohoku Earthquake and Tsunami

*) Source: “Statistics for Employment Stabilization” by Ministry of Health, Labour and Welfare, “Workforce Research” by Ministry of Internal and Communications

Job to application ratio

The job to application ratio in long term care service

sector is higher than all other industry average.

4

(times)

0

0,5

1

1,5

2

2,5

3

3,5

4

FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015

Industry average

Long term care service

Source; MHLW and JILPT

Labor force is expected to decrease by 7.9M in 15years.

Assuming that the labor force rate increases with appropriate

economic growth, the decrease would be 1.8M.

10.4 9.8 10.2 8.9 9.8

40.7 39.3 40.8 35.4 37.8

12.3 11.4 12.8

11.3 14.1

（実績値） 経済成長と労働参加が

適切に進まないケース

経済成長と労働参加が

適切に進むケース

経済成長と労働参加が

適切に進まないケース

経済成長と労働参加が

適切に進むケース

2014年 2020年 2030年

Labor Force Simulation (2020 & 2030, Male & female total)

+2.8 million

+2.4 million

+0.9 million

30 – 59

yrs old

15 – 29

yrs old

60 yrs or

above

+1.5 million

+0.4 million

+1.4 million

60.5 million （-3.1 million）

63.8 million （+ 0.3 million）

55.6 million （-7.9 million）

61.7 million （- 1.8 million）

Increase by 3.4 million Increase by 6.1 million

63.5 million

(Actual)

2014 2020

(Scenario) Stagnant

economic growth and

labor force participation

(Scenario) Stagnant

economic growth and

labor force participation

2020 Scra

2030

(Scenario) Appropriate

economic growth and

labor force participation

(Scenario) Appropriate

economic growth and

labor force participation

5

5,1 4,8 4,2

10,0 10,3

9,9

11,0 10,6

9,6

7,5 8,6

9,6

0

2

4

6

8

10

12

2014 2020 2030

Mining/Construction Manufacturing Retail/whole sale Medical/Welfare

The number of employees in health and welfare sector will be

equivalent to that of retail and whole sale sector in 2030.

30% of nurses, 40% of certified care workers, and 60% of

nursery teachers do not work despite having professional

licenses.

（Million）

Source; MHLW 6

More than 1 million workers increase

is required by 2025.

Nurses; 1.6M in 2014

1.96 – 2.06M in 2025

Care Worker; 1.71M in 2013

2.31M in 2020

2.53M + α in 2025

7

Total Male Female

Average

age

Years of

employme

nt

Monthly

salary

Male

compositi

on

Average

age

Years of

employme

nt

Monthly

salary

Female

compositi

on

Average

age

Year of

employme

nt

Monthly

salary

（year） (JPY/000） （%） (year) (JPY/000) (%) (year) (JPY/000)

By Industry

Industry total 42.3 12.1 333.3 66.6 43.1 13.5 370.3 33.4 40.7 9.4 259.6

Medical/welfare 40.9 8.3 301.5 28.1 40.6 8.6 379.4 71.9 41.0 8.2 271.0

Social insurance/social

welfare/nursing care 41.7 7.6 246.5 29.6 40.6 7.8 277.6 70.4 42.2 7.5 233.4

Service 44.6 9.4 282.1 70.0 45.9 10.1 305.3 30.0 41.7 7.5 227.9

By

Occupation

Doctor 40.0 5.1 848.4 73.8 41.1 5.3 910.6 26.2 37.0 4.4 673.2

Nurse 38.2 7.8 329.2 9.3 35.2 6.7 335.3 90.7 38.5 7.9 328.6

Assistant nurse 48.3 10.9 277.4 9.1 41.5 10.0 292.0 90.9 49.0 10.9 275.9

Physical

therapist/Occupational

therapist

31.5 5.3 284.0 53.7 31.9 5.2 292.1 46.2 31.1 5.3 274.7

Nursery staff 35.0 7.6 219.2 5.3 30.9 5.8 238.2 94.7 35.2 7.7 218.2

Care manager 47.0 8.7 261.6 27.5 42.2 7.8 281.7 72.5 48.9 9.1 254.0

Home helper 45.3 6.6 225.1 22.2 37.5 4.3 237.7 77.8 47.6 7.2 221.5

Welfare service worker 39.7 6.0 223.5 34.4 37.3 5.9 238.8 65.6 41.0 6.1 215.5

Source: MHLW

Care worker wages are lower than the average of all

industries.

8

Source; MHLW andCare Worker Foundation

15,4 14,6 16,4 14,5 14,4 14,8 15,6 15,5

21,6

18,7 17,0 17,8

16,1 17,0 16,6 16,5

10

15

20

25

30

2007 2008 2009 2010 2011 2012 2013 2014

Comparison of Turnover Rate

Inustry average Care worker

（％）

15,9 14,2

15,5 14,3 14,2 14,8

16,3 17,3

27,4

22,6

25,2 25,8

21,0 23,3

21,7 20,6

10

15

20

25

30

2007 2008 2009 2010 2011 2012 2013 2014

Comparison of New Hiring Rate

Industry ave. Care workers

（％）

New hiring rate and turn over rate are relatively higher

than the average.

9

10

31,7%

25,0% 24,7% 23,5% 22,0%

18,9%

14,3% 13,2% 13,1% 12,2% 10,9%

5,3% 4,2% 3,7% 2,0% 0,9%

19,7%

0%

10%

20%

30%

40%

Ma

rriag

e, C

hild

birth

, Child

rea

r

dis

sa

tisfie

d w

ith w

ork

pla

ce

p

olic

ies

Rela

tion

sh

ip w

ith o

the

r wo

rke

rs

Lo

w s

ala

ry

Hea

lth p

rob

lem

(excl. b

acka

ch

e),

rea

ch

ed

retirin

g a

ge

Dis

sa

tisfie

d w

ith w

ork

h

ou

rs/h

olid

ay/w

ork

sh

ift

Ba

cka

ch

e

Cou

ld n

ot d

eve

lop

exp

teris

e fu

lly

Eld

erly

ca

re

La

ck o

f ca

ree

r de

ve

lop

me

nt

wa

nte

d to

exp

erie

nce

difffe

ren

t job

Relo

ca

tion

of fa

mily

me

mb

er

Ob

tain

ed

ce

rtifica

te/q

ua

lifica

tion

Restru

ctu

ring

, layo

ff, liqu

ida

tion

Pe

rso

na

l issu

e w

ith o

the

r fam

ily

me

mb

er

Esta

bis

he

d o

wn

bu

sin

ess

Oth

ers

Source; Social Welfare Promotion and National Examination Center

Marriage/Child rearing, Workplace policies, and

Relationship with other workers are the main reasons for

leaving their jobs.

High

turnover

Future career path is

not visionary

Target goal is Mt. Fuji shape which has broader

entrance as well as higher and more clear career

ladder.

Function

between

professional

and no

professional is

mixed up

Not labor

force with

licenses

Highly Professional

Basic Level

11

Limited entry Limited entry

12

Wage Increase (reimbursement price premium ($270))

No refund educational loan

Registry System for licensed care workers leaving the industry

Maternity Leave and Child Care Services

Wage increase is supported through long-term care

insurance system.

13

Improving expertise of care workers will bring

productivity increase

Care workers with training are allowed to conduct

sputum suction.

Nurses with training are allowed to conduct specified

medical treatment such as

Decubitus removal, Drain removal, Quantity adjustment of insulin injection

Visualize capability and expertise of care workers

Career Grade System for long term care services was introduced.

Higher Productivity will result in Higher wages

14

Non-professional workers such as retired, community

volunteer will be utilized for shopping/walking support,

cooking and cleaning.

Service revision for people with lower care needs.

(More preventive , More independent, More improvement)

Optimizing the allocation of human resources is

required

Professional Long Term Care Career Grades

Level Features

Professional

Level

7 Top Professional as representative of

each sector

6 Highly professional, originality of care

services 5

4 Excises leadership in a team

3 Independently providing services

without direction.

2 Providing services with direction.

1 Finished Basic Training

15

“Welfare service vision with response to

demand of new era” was released in Sep 2016.

16

Family issue is more complicated and more cross sectoral

System is working sector by sector

child welfare

long term care

welfare for disabled

welfare for low income family

Shrinking demographic will cause shortage of human resources and infrastructure in welfare services

• Comprehensive consultation system

• Multi generational and functional service center

• Comprehensive educational system for multi functional services

• Introduction of Innovation as well as improvement of service flow efficiency

17

Create community where individuals supports

everyone mutually.

There is no distinction between supporter and

supported in such community.

This concept will lead us to Inclusive society.

18

Case 1

Case 2

19

Case 3

20

Example of Licenses

【Health Care】

Nurse

OT

PT

ST

ORT

Radiology Technologist

Clinical Laboratory

Technologist

Certified Social Worker

Certified Care Worker

PSW

Nursery Teacher

License

Ａ

License

Ｂ

License

Ｃ

Ａ

Ｂ

Ｃ

Common Curriculum

2 years

3 years

21

We are planning to create a common curriculum

between licenses

Complicated case

Efficient allocation

Mobility increase

New career ladder

【Welfare】

22

Number of Immigration by ＥＰＡ（as of 2016/1/1）

Number of

Immigration

Accepted Candidates Qualification Obtained

Working Contract

terminated &

left Japan Total Working

Contract

terminated &

left Japan

Indonesia 966 528 224 214 135 79

Philippines 885 502 242 141 115 26

Vietnam 255 253 2 － － －

Total 2106 1283 468 355 250 105

（number of immigration）

Source: JICWELS

Long term care robot development promotion project

Idea

Development

Marketing Project for Development of Service Method

Practical Trial Supporting Project

Needs and Seed Matching Project

Monitoring Research

Campaign on outcome of trail use

Providing information on

proposal from on site

workers

Deployment of effective

utilization of the robot

23

Okayama city was designated as Special Zone for

Home Care Service Model Development

24

Sensor Mattress

PARO(Seal type

therapeutic robot)

Power Assist

Gloves

Kabo-can

(Communication Robot)

Rakunie

(Lamber Support Wear) One hand walking assist

Robots and various devices to support home care

PARO react human’s touch and voice, which

improves cognitive symptoms

JPY3,000/month (excl. tax)

Target user: People requiring care (level 1-5)

Sensor mattress monitors caretaker’s

daily life via tablet/mobile phone

JPY1,780/month (excl. tax)

Target user: People requiring care

(level 1-5)

Support grasping movement by air

pressure

JPY1,700/month (excl. tax)

Target user: People requiring care (level 1-

5), People requiring support (level 1-2)

Improve cognitive symptoms

through communication with

Kabo-can

JPY150 /month (excl. tax)

Target user: People requiring

care (level 1-5), people requiring

support (level 1-2)

Help care giver’s physical

burden

JPY600 /month (excl. tax)

Target user: People requiring

care (level 1-5), people

requiring support (level 1-2) and

care givers

Help the half-paralyzed to

stand and walk

JPY350 /month (excl. tax)

Target user: People

requiring care (level 1-2),

people requiring support

(level 1-2)

Source: Okayama City Government

Voice and screen display reminds you of

taking the medication. Digital light and voice reminds of you

medication time and details.

Barrier-free tatami helps wheelchair users to

move at home or nursing home.

JPY1,500/month (excl. tax) JPY850/month (excl. tax) JPY800/month (excl. tax)

This power walking robot assists you with

curve or slope. GPS tracking function

supports home care. JPY1,500/month (excl. tax)

Auto-wrapping defecation treatment using

thermocompression reduces care giver’s

burden. JPY1,000/month (excl. tax) JPY800/month (excl. tax)

Walking Assist

Medication Aids Robot

Walking Assist Robot RT.1

Medication Aids Robot

Toileting Aids

Auto-wrapping defecation treatment system

Medication Aids

Home medication aids

Take medicine !

Everyday Life Support

Tatami customized for care takers

Barrier-free Slope

Walking Assist

ＡＣＳＩＶＥ

It doesn't require the use of electricity nor

motor, but is powered by a cam spring

mechanism.

24 Source: Okayama City Government

-25

-20

-15

-10

-5

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14

DBD points

DBD has dropped

dramatically

after 6 month use of PARO

23.2点 month

26 Source; Okayama city

Ms. A case Age 90, Female

• Care need 5 (highest)

• Dementia Independency Ⅳ （Second highest)

• Abusive to care workers

• Strong demand to be spoiled by her son

Outstanding improvement was seen in 13 month use of PARO

• DBM 20 → 16

• NM scale 17 → 21

• Zarit 40 → 13

27 Source: Okayama City Government